Aging, Ageism and Abuse: Moving from Awareness to Action

Spencer

Brief Table of Contents

Front-matter

Copyright

Preface

Contributors’ biographies

Chapter 1. Social issues and social policy response to abuse and neglect of older adults

Chapter 2. Abuse in later life

Chapter 3. The invisible problem of abused older men

Chapter 4. Abuse of lesbian, gay, transgender, and bisexual elders

Chapter 5. Union perspectives on abuse prevention in long-term care

Chapter 6. Abuse of older adults

Chapter 7. Seneca College’s design for social change course

Table of Contents

Front-matter

Copyright

Preface

Contributors’ biographies

Chapter 1. Social issues and social policy response to abuse and neglect of older adults

Social Issues Related to Abuse and Neglect of Older Adults

Ageism and lack of respect

Social biases that privilege frailty and protection over empowerment of older adults

Difficulties current generation of older adults experience in speaking out against their own experience of abuse

Aging of the population: a global phenomenon in developed countries and countries under development

Diversity of older adults (ethnic, cultural, mental, cognitive, and physical)

Differences in life situations of older women and older men

Families in later life

Differences and similarities in community and institutional senior abuse

Complex social responses to diverse forms of senior abuse

Social Policy Response to Abuse and Neglect of Older Adults: Challenges

Prevention and early intervention versus protection

Social health and service versus criminal justice response

Geriatric versus feminist perspective

Lack of clear and consistent definitions and reliable and quantifiable data

Lack of perceived power among victims and providers to effect change in public policy

Lack of consensus among provider and advocacy community on remedies

Fragmentation, service gaps, lack of funding, and under-funding for services to older adults and their families

United States Public Policy Responses

Two legislative examples

Example of a US national coalition building effort

Example of a state/local coalition building effort

International Public Policy to Address Senior Abuse

Conclusion

Chapter 2. Abuse in later life

Defining Elder Abuse and Violence Against Women

Two Inter-Linked Silos

Quantitative and Qualitative Research: A Snapshot

Qualitative Research

Policy and Legislation

Conclusion

Chapter 3. The invisible problem of abused older men

Elder Abuse as a Woman’s Problem

Findings Regarding the Abuse of Older Men

Special Groups of Vulnerable Older Men

The Invisibility of Abused Older Men

Explanations for the Abuse of Older Men

Failure to use Community Services

Combating the Abuse of Older Men

Conclusion

Chapter 4. Abuse of lesbian, gay, transgender, and bisexual elders

Impact of History

Internalized Homo/Trans/Biphobia

Interpersonal Abuse

Exploitation

Ageism in LGTB Communities

Homophobia = Abuse and Neglect

Heterosexism = Systemic Abuse and Neglect

Policy Issues

Conclusion

Chapter 5. Union perspectives on abuse prevention in long-term care

Union Context and History

Individual Level Factors: The Union Role

Facility- and System-Level Issues

Facility-Level Actions

System-Level Actions

Conclusion

Chapter 6. Abuse of older adults

Framing the Problem

Definitions and Terminology

Financial Abuse of Older Adults

How can the justice system better respond to such a situation? What recommendations can criminal justice practitioners provide?

How should customer service staff, financial planners, or managers act in situations where they suspect financial abuse?

What about privacy concerns?

Local law enforcement as a resource

What about legislation?

Current Status of Abuse and Neglect Cases in the Criminal Justice System: An Ontario Perspective

Specialized seniors’ fraud units and S.C.A.T.

Police service standards and guidelines

Practice memorandum for crown attorneys

Multilanguage interpretation

L.E.A.P.S.

Elder abuse coordinator

Senior crime stoppers

OACP resolution

Ontario’s strategy to combat elder abuse

Recommendations for Justice Practitioners

Conclusion

Chapter 7. Seneca College’s design for social change course

The First Class

Objective of this Chapter

The Evolution of the Design for Social Change Course

Projects Brought to the Course

Purposes of the Course

Role of the client

Contrast between some Typical Agency Procedures and the DFSC Class Procedures

The Bottom-Up Research Phase

Client’s Role as Facilitator

Who Owns the Final Projects? What has Happened to them?

Conclusion

Front-matter

Aging, Ageism and Abuse: Moving from Awareness to Action

Aging, Ageism and Abuse: Moving from Awareness to Action

Edited by

Gloria Gutman and Charmaine Spencer

AMSTERDAM • BOSTON • HEIDELBERG • LONDON • NEW YORK • OXFORD • PARIS • SAN DIEGO • SAN FRANCISCO • SINGAPORE • SYDNEY • TOKYO

Copyright

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Preface

In developing this book, we had three main objectives: (1) to underscore the important of recognizing and addressing the ageism that underlies much of the abuse and neglect of older persons that is taking place around the world; (2) to draw attention to the diversity of those who are victims and perpetrators of elder abuse and neglect; and (3) to highlight the need to move beyond raising awareness to taking action on the policy level as well as on the ground and to providing some examples that it is occurring.

The idea for this volume originated at a conference by the same title held at Simon Fraser University, Vancouver, British Columbia, May 11–12, 2006. The conference was the first activity in the province leading up to the first-ever World Elder Abuse Awareness Day, which took place on June 15, 2006. The conference organizers, Gloria Gutman and Charmaine Spencer, who are also the editors of this volume, were intimately involved in the conception and evolution of World Elder Abuse Awareness Day (WEAAD), helping its founder, Elizabeth Podnieks, to take it from the idea stage (expressed in an informal telephone call early one morning in 2004) to the point where groups and agencies from around the world now routinely organize and host public awareness-raising events on June 15.

In five short years, WEAAD has captured the imagination of people working in the elder abuse and neglect area because they recognized that the topic had to go public if a majority of victims were to come forward and seek help, if evidence-based and cost-effective services were to be developed and made available in sufficient quantity to meet current and future needs, and if activities directed at prevention were to be successful. For far too long, elder abuse and neglect has been a hidden problem. As Patricia Brownell points out in Chapter 1, the numbers of older persons are growing in virtually all parts of the world. If current prevalence rates continue to hold, we can expect an increasing number of elder abuse and neglect cases unless steps are taken to address the conditions that lead to its occurrence. She underscores the fact that elder abuse and neglect is not just a developed world phenomenon. Especially worrisome for the future, is the additional fact that the pace of population aging is most rapid in less developed countries that have less infrastructure and fewer resources to offer a burgeoning aging population than the developed world, where the rate of growth was slower. For example, it took France 125 years to reach the point of having 7% of its population aged 65 and over, which defined it as an old society, compared with an estimated 25 years to reach this threshold in China. Within the senior population, the most rapid gains in population proportion are among the oldest-old, which is particularly important for estimating the potential size of elder abuse and neglect as a continuing social problem. The oldest-old by definition are the most frail—physically and mentally—so they are the most vulnerable to maltreatment by others.

To date, much of the work on identification, treatment, and prevention of elder abuse and neglect has focused on family dynamics and settings. But population aging is not taking place in a vacuum. Rather, it is occurring simultaneously with other social changes and trends—urbanization and migration are two that seriously impact the older population, leaving many without the safety net of a loving family in geographic proximity to care of them when they are unable to meet their daily needs independently. Falling birth rates mean that in future, many more older people than ever before will have no offspring—loving or unloving, leaving them to be cared for by non-kin or not at all.

There is much discussion in the elder abuse literature about the need for a universally accepted definition of abuse and neglect of older adults that will apply both to situations involving kin and to those involving non-kin, and to both maltreatment that occurs in community settings and that which occurs in institutional settings.

Three definitions are in fairly common use around the world. The first, found on the US National Center on Elder Abuse website, defines it as: … any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult.NCEA (2008)

A second definition, used by the US National Research Council’s Panel to Review Risk and Prevalence of Elder Abuse and Neglect, places less importance on determining intentionality and draws attention to the relationship between the victim and perpetrator, defining elder mistreatment as: … (a) intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder or (b) failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm.Bonnie and Wallace (2003, p. 1)

A third, and perhaps the most commonly used, was developed by the UK’s Action on Elder Abuse in 1995 and subsequently adopted by the World Health Organization (WHO) and the International Network for the Prevention of Elder Abuse (INPEA) for their Missing Voices project: … a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person.WHO/INPEA (2002, p. 3)

As Spencer and Gutman (2008) note, the concept of trust is a key part of the WHO/INPEA definition. It speaks to an expectation of trust—there does not have to be an actual trust relationship between persons. Stones (1995) argues that certain relationships are trust relationships by virtue of kin relationship and social definition (e.g., family, neighbors, friends), or by legal context (contract or specific authority, as in the case of home support workers, health care providers, banking staff, and lawyers).

Spencer and Gutman (2008) note, however, that while the WHO/INPEA definition is useful for some purposes, it tends generally to be imprecise when used as a basis for estimating prevalence, incidence, and risk factors for elder abuse and neglect. At a minimum, a useful definition will be one that can clearly identify scope: who is being harmed (i.e. victims), type of harms, threshold (consequences/effect) and who is doing the harm (perpetrators).Spencer and Gutman (2008, p. 10)

In this volume, several of the authors echo our concern about definitional vagueness. There is also some discussion about the difficulties of estimating the prevalence, incidence, and risk factors for abuse and neglect, due to the use of different research methodologies by different investigators. At the base of this discussion is the fact that this is an extremely complex domain in which, it is generally agreed, an all-hazards or one-size-fits-all approach is inappropriate. Lachs and Pillemer (2004) in a now classic article published in The Lancet and Garre-Olmo et al. (2009) in a